Are You Old Enough to Get Vaccinated? In Tennessee, They’re Using the Honor System

In December, all states began vaccinating only health care workers and residents and staffers of nursing homes in the “phase 1A” priority group. But, since the new year began, some states have also started giving shots to — or booking appointments for — other categories of seniors and essential workers.

As states widen eligibility requirements for who can get a covid-19 vaccine, health officials are often taking people’s word that they qualify, thereby prioritizing efficiency over strict adherence to distribution plans.


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“We are doing everything possible to vaccinate only those ‘in phase,’ but we won’t turn away someone who has scheduled their vaccine appointment and tells us that they are in phase if they do not have proof or ID,” said Bill Christian, spokesperson for the Tennessee Department of Health.

Among the states pivoting to vaccinating all seniors, timelines and strategies vary. Tennessee started offering shots to people 75 and older on Jan. 1. So, Frank Bargatze of Murfreesboro, Tennessee, snagged an appointment online for his father — and then went ahead and put his own name in, though he’s only 63.

“He’s 88,” Bargatze said, pointing to his father in the passenger seat after they both received their initial shots at a drive-thru vaccination site in Murfreesboro, a large city outside Nashville. “I jumped on his bandwagon,” he added with a laugh. “I’m going to blame it on him.”

Bargatze does work a few days a week with people in recovery from addiction, he added, so in a way, he might qualify as a health care worker.

Some departments are trying more than others, but overwhelmed public health departments don’t have time to do much vetting.

Dr. Lorraine MacDonald is the medical examiner in Rutherford County, Tennessee, where she’s been staffing the vaccination site. If people seeking the vaccine make it through the sign-up process online, MacDonald said, and show up for their appointment, health officials are not going to ask any more questions — as long as they’re on the list from the online sign-up.

“That’s a difficult one,” MacDonald acknowledged, when asked about people just under the age cutoff joining with older family members and putting themselves down for a dose, too. “It’s pretty much the honor system.”

People getting vaccinated in several Tennessee counties told a reporter they did not have to show ID or proof of qualifying employment when they arrived at a vaccination site. Tennessee’s health departments are generally erring on the side of simply giving the shot, even if the person is not a local resident or is not in the country legally.

The loose enforcement of the distribution phases extends to other parts of the country, including Los Angeles. In response, New York’s governor is considering making line-skipping a punishable offense.

Still, many people who don’t qualify on paper believe they might need the vaccine as much as those who do qualify in the initial phases.

Gayle Boyd of Murfreesboro is 74, meaning she didn’t quite make the cutoff in Tennessee, which is 75. But she’s also in remission from lung cancer, and so eager to get the vaccine and start getting back to a more normal life, that she joined her slightly older husband at the Murfreesboro vaccination site this week.

“Nobody’s really challenged me on it,” she said, noting she made sure to tell vaccination staffers about her medical issues. “Everybody’s been exceptionally nice.”

Technically, in the state’s current vaccine plan, having a respiratory risk factor like lung cancer doesn’t leapfrog anyone who doesn’t otherwise qualify. But in some neighboring states such as Georgia, where the minimum age limit is 65, Boyd would qualify.

Even for those who sympathize with such situations, anecdotes about line-skipping enrage many trying to wait their turn.

“We try to be responsible,” said 57-year-old Gina Kay Reid of Eagleville, Tennessee.

Reid was also at the Murfreesboro vaccination site, sitting in the back seat as she accompanied her older husband and her mother. She said she didn’t think about trying to join them in getting their first doses of vaccine. “If you take one and don’t necessarily need it, you’re knocking out somebody else that is in that higher-risk group.”

But there is a way for younger, healthier people to get the vaccine sooner than later — and not take a dose away from anyone more deserving.

A growing number of jurisdictions are realizing they have leftover doses at the end of every day. And the shots can’t be stored overnight once they’re thawed. So some pharmacists, such as some in Washington, D.C., are offering them to anyone nearby.

Jackson, Tennesse, has established a “rapid response” list for anyone willing to make it down to the health department within 30 minutes. Dr. Lisa Piercey, the state’s health commissioner, said her own aunt and uncle received a call at 8 p.m. and rushed to the county vaccination site to get their doses.

Piercey called it a “best practice” that she hopes other jurisdictions will adopt, offering a way for people eager for the vaccine to get it, while also helping states avoid wasting precious doses.

This story is part of a partnership that include WPLN, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Trump Administration Approves First Medicaid Block Grant, in Tennessee

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With just a dozen days left in power, the Trump administration on Friday approved a radically different Medicaid financing system in Tennessee that for the first time would give the state broad authority in running the health insurance program for the poor in exchange for capping its annual federal funding.

The approval is a 10-year “experiment.” Instead of the open-ended federal funding that rises with higher enrollment and health costs, Tennessee will instead get an annual block grant. The approach has been pushed for decades by conservatives who say states too often chafe under strict federal guidelines about enrollment and coverage and can find ways to provide care more efficiently.

The approval, however, faces an uncertain future because the incoming Biden administration is likely to oppose such a move. But to unravel it, officials would need to set up a review that includes a public hearing.

Meanwhile, the changes in Tennessee will take months to implement because they need final legislative approval, and state officials must negotiate quality of care targets with the administration.

TennCare, the state’s Medicaid program, said the block grant system would give it unprecedented flexibility to decide who is covered and what services it will pay for.

It said the new arrangement would allow the state to keep part of the money it saves from operating the program more efficiently. Trump administration officials said the approach adds incentive for the state to save money, unlike the current system, in which increased state spending is matched with more federal dollars. If Medicaid enrollment grows, the state can secure additional federal funding. If enrollment drops, it will get less money.

“This groundbreaking waiver puts guardrails in place to ensure appropriate oversight and protections for beneficiaries, while also creating incentives for states to manage costs while holding them accountable for improving access, quality and health outcomes,” said Seema Verma, administrator of the Centers for Medicare & Medicaid Services. “It’s no exaggeration to say that this carefully crafted demonstration could be a national model moving forward.”

Opponents, including most advocates for low-income Americans, say the approach will threaten care for the 1.4 million people in TennCare, which includes children, pregnant women and the disabled. Federal funding covers two-thirds of the cost of the program.

Michele Johnson, executive director of the Tennessee Justice Center, said the block grant approval is a step backward for the state’s Medicaid program.

“No other state has sought a block grant, and for good reason. It gives state officials a blank check and creates financial incentives to cut health care to vulnerable families,” she said.

Democrats have fought back block grant Medicaid proposals since the Reagan administration and most recently in 2018 as part of Republicans’ failed effort to repeal and replace major parts of the Affordable Care Act. Even some key Republicans opposed the idea because it would cut billions in funding to states that would make it harder to help the poor.

Implementing block grants via an executive branch action rather than getting Congress to amend Medicaid law is also likely to be met with court challenges.

The block grant approval comes as Medicaid enrollment is at its highest ever level.

More than 76 million Americans are covered by the state-federal health program, a million more than when the Trump administration took charge in 2017. Enrollment has jumped by more than 5 million in the past year as the economy slumped with the pandemic.

Medicaid, part of President Lyndon B. Johnson’s “Great Society” initiative of the 1960s, is an entitlement program in which the government pays each state a certain percentage of the cost of care for anyone eligible for the health coverage. As a result, the more money states spend on Medicaid, the more they get from Washington.

Under the approved demonstration, CMS will work with Tennessee to set spending targets that will increase at a fixed amount each year.

The plan includes a “safety valve” to increase federal funding due to unexpected increases in enrollment.

“The safety valve will maintain Tennessee’s commitment to enroll all eligible Tennesseans with no reduction in today’s benefits for beneficiaries,” CMS said in a statement.

Tennessee has committed to maintaining coverage for eligible beneficiaries and existing services.

In exchange for taking on this financing approach, the state will receive a range of operating flexibilities from the federal government, as well as up to 55% of the savings generated on an annual basis when spending falls below the aggregate spending cap and the state meets certain quality targets, yet to be determined.

The state can spend that money on various health programs for residents, including areas that Medicaid funding typically doesn’t cover, such as improving transportation and education and employment.

The 10-year waiver is unusual, but the Trump administration has approved such long-term experiments in recent years to give states more flexibility.

Tennessee is one of 12 states that have not approved expanding Medicaid under the Affordable Care Act that’s left tens of thousands of working adults without health insurance.

“The block grant is just another example of putting politics ahead of health care during this pandemic,” said Johnson of the Tennessee Justice Center. “Now is absolutely not the time to waste our energy and resources limiting who can access health care.”

State officials applauded the approval.

“It’s a legacy accomplishment,” said Tennessee Gov. Bill Lee, a Republican. “This new flexibility means we can work toward improving maternal health coverage and clearing the waiting list for developmentally disabled.”

“This means we will be able to make additional investments in TennCare without reduction in services and provider cuts.”

KHN chief Washington correspondent Julie Rovner contributed to this report.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Con récord de internaciones por COVID, la crisis ahora es la falta de personal médico

Los hospitales en gran parte del país están tratando de hacer frente a un número sin precedentes de pacientes con COVID-19.

El lunes 30 de noviembre hubo 96,039 internaciones a lo largo del país, un récord alarmante que supera con creces los dos picos anteriores en abril y julio de poco menos de 60,000 pacientes hospitalizados.

Pero las camas y el espacio no son la principal preocupación. Es la fuerza laboral. A los hospitales les preocupa que los niveles de personal no puedan satisfacer la demanda, ya que los médicos, enfermeras y especialistas, como los terapeutas respiratorios, se agotan o, peor aún, se infectan y enferman.

La solución típica para la escasez de personal (contratar médicos de afuera) ya no es la solución, a pesar de que ayudó a aliviar la tensión al principio de la pandemia, cuando el primer aumento de casos se concentró en un puñado de “puntos calientes” como Nueva York, Detroit, Seattle y Nueva Orleans.

Reclutar esos refuerzos temporales también fue más fácil en la primavera porque los hospitales fuera de esas primeras ciudades afectadas estaban atendiendo a menos pacientes de lo normal, lo que llevó a despidos masivos.

Eso hizo que muchas enfermeras cesantes no dudaran en viajar a otra ciudad y ayudar en otro frente de batalla.

En muchos casos, los hospitales compitieron por las enfermeras itinerantes y las tasas de pago de las enfermeras temporales se dispararon. En abril, el Centro Médico de la Universidad de Vanderbilt en Nashville, Tennessee, tuvo que aumentar el salario de algunas enfermeras del personal, que ganaban menos que las temporales recién llegadas.

En la primavera, estas enfermeras que viajaron a las “zonas calientes” no solo recibieron mejores salarios. Muchas contaron lo gratificante que fue salvar vidas en una pandemia histórica, estar cerca de pacientes que morían lejos de su familia.

“Era realmente una zona caliente, no nos sacábamos el equipo de protección y todos los que ingresaban eran COVID positivos”, contó Laura Williams, de Knoxville, Tennessee, quien ayudó a inaugurar el Ryan Larkin Field Hospital en la ciudad de Nueva York.

“Trabajaba seis o siete días a la semana, pero me sentí muy realizada”.

Después de dos meses agotadores, Williams regresó en junio a su trabajo de enfermería en el Centro Médico de la Universidad de Tennessee. Durante un tiempo, el frente de COVID se mantuvo relativamente tranquilo en Knoxville.

Pero luego golpeó la segunda ola. Y ha habido hospitalizaciones récord en Tennessee casi todos los días: aumentaron un 60% en el último mes.

Los funcionarios de salud informan que es mucho más difícil encontrar médicos suplentes.

Tennessee ha construido sus propios hospitales de campaña para manejar el desborde de pacientes: uno se encuentra dentro de las antiguas oficinas del periódico Commercial Appeal en Memphis y otro ocupa dos pisos sin usar en el Nashville General Hospital.

Pero si fueran necesarios en este momento, el estado tendría problemas para encontrar médicos y enfermeras para administrarlos porque los hospitales ya están luchando para cubrir las camas que tienen.

“La capacidad hospitalaria depende casi exclusivamente de la dotación de personal”, explicó la doctora Lisa Piercey, quien dirige el Departamento de Salud de Tennessee. “Las camas no son el problema”.

Cuando se trata de dotación de personal, el coronavirus crea un desafío extremo.

A medida que el número de casos alcanza nuevos picos, un número récord de empleados del hospital tienen COVID-19 o se ven obligados a dejar de trabajar porque tienen que ponerse en cuarentena después de una posible exposición.

“Pero aquí está la trampa”, dijo el doctor Alex Jahangir, que preside el grupo de trabajo sobre el coronavirus de Nashville. “No se infectan en los hospitales. De hecho, los hospitales en su mayor parte son bastante seguros. Se están infectando en la comunidad”.

Algunos estados, como Dakota del Norte, ya han decidido permitir que las enfermeras con COVID positivo sigan trabajando mientras se sientan bien, una medida que ha generado una reacción violenta.

La escasez de enfermeras es tan aguda que algunos puestos de enfermeras itinerantes pagan un salario de $8,000 a la semana. A algunas enfermeras y médicos jubilados se les pidió que consideraran regresar a la fuerza laboral al comienzo de la pandemia, y al menos 338 de 65 años o más murieron de COVID-19.

En Tennessee, el gobernador Bill Lee emitió una orden de emergencia que flexibiliza algunas restricciones regulatorias sobre quién puede hacer qué dentro de un hospital, dándoles más flexibilidad al personal.

La doctora Jessica Rosen es médica de emergencias en St. Thomas Health en Nashville, donde tener que derivar pacientes a otros hospitales era algo raro. Dijo que ahora es algo común.

“Tratamos de enviar ambulancias a otros hospitales porque no tenemos camas disponibles”, expresó.

Incluso los hospitales más grandes de la región se están llenando. La primera semana de diciembre, el Centro Médico de la Universidad de Vanderbilt abrió espacio en su hospital infantil para pacientes que no tenían COVID. Su hospital de adultos tiene más de 700 camas. Y como muchos otros hospitales, ha enfrentado el desafío de dotar de personal a dos unidades de cuidados intensivos, una exclusivamente para pacientes con COVID y otra para todos los demás.

Y los pacientes vienen de lugares tan lejanos como Arkansas y el suroeste de Virginia.

“La gran mayoría de nuestros pacientes que ahora están en la unidad de cuidados intensivos no ingresan a través de nuestro departamento de emergencias”, dijo el doctor Matthew Semler, neumonólogo en VUMC que trabaja con pacientes con COVID.

“Los transfieren a este centro, que está a horas de distancia, porque no hay capacidad en ningún otro”.

Semler dijo que su hospital normalmente traía enfermeras de fuera de la ciudad para ayudar. Pero ya no hay.

Los grupos de proveedores nacionales todavía están enviando personal, aunque cada vez más significa dejar a otro lugar con menos trabajadores. El doctor James Johnson, de la empresa de servicios médicos Envision, con sede en Nashville, ha desplegado refuerzos en Lubbock y El Paso, Texas.

Con esta crisis, la limitación no serán los ventiladores o el equipo de protección, dijo. En la mayoría de los casos, será la fuerza laboral médica. El poder de la gente.

Johnson, veterano de la Fuerza Aérea que trató a soldados heridos en Afganistán, dijo que está más concentrado que nunca en tratar de levantar la moral de los médicos y evitar el agotamiento. En general, es optimista, especialmente después de servir cuatro semanas en la ciudad de Nueva York al comienzo de la pandemia.

“Lo que experimentamos en Nueva York, y desde entonces, muestra que la humanidad está a la altura de las circunstancias”, dijo.

Pero Johnson agregó que los sacrificios no deberían provenir solo de los trabajadores de salud. Todos son responsables de tratar de evitar que los demás, y ellos mismos, se enfermen en primer lugar, dijo.

Esta historia es parte de una colaboración que incluye Nashville Public Radio, NPR y Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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As Hospitals Fill With COVID Patients, Medical Reinforcements Are Hard to Find

Hospitals in much of the country are trying to cope with unprecedented numbers of COVID-19 patients. As of Monday, 96,039 were hospitalized, an alarming record that far exceeds the two previous peaks in April and July of just under 60,000 inpatients.

But beds and space aren’t the main concern. It’s the workforce. Hospitals are worried staffing levels won’t be able to keep up with demand as doctors, nurses and specialists such as respiratory therapists become exhausted or, worse, infected and sick themselves.

The typical workaround for staffing shortages — hiring clinicians from out of town — isn’t the solution anymore, even though it helped ease the strain early in the pandemic, when the first surge of cases was concentrated in a handful of “hot spot” cities such as New York, Detroit, Seattle and New Orleans.

Recruiting those temporary reinforcements was also easier in the spring because hospitals outside of the initial hot spots were seeing fewer patients than normal, which led to mass layoffs. That meant many nurses were able — and excited — to catch a flight to another city and help with treatment on the front lines.

In many cases, hospitals competed for traveling nurses, and the payment rates for temporary nurses spiked. In April, Vanderbilt University Medical Center in Nashville, Tennessee, had to increase the pay of some staff nurses, who were making less than newly arrived temporary nurses.

In the spring, nurses who answered the call from beleaguered “hot spot” hospitals weren’t merely able to command higher pay. Some also spoke about how meaningful and gratifying the work felt, trying to save lives in a historic pandemic, or the importance of being present for family members who could not visit loved ones who were sick or dying.

“It was really a hot zone, and we were always in full PPE and everyone who was admitted was COVID-positive,” said Laura Williams of Knoxville, Tennessee, who helped launch the Ryan Larkin Field Hospital in New York City.

“I was working six or seven days a week, but I felt very invigorated.”

After two taxing months, Williams returned in June to her nursing job at the University of Tennessee Medical Center. For a while, the COVID front remained relatively quiet in Knoxville. Then the fall surge hit. There have been record hospitalizations in Tennessee nearly every day, increasing by 60% in the past month.

Health officials report that backup clinicians are becoming much harder to find.

Tennessee has built its own field hospitals to handle patient overflows — one is inside the old Commercial Appeal newspaper offices in Memphis, and another occupies two unused floors in Nashville General Hospital. But if they were needed right now, the state would have trouble finding the doctors and nurses to run them because hospitals are already struggling to staff the beds they have.

“Hospital capacity is almost exclusively about staffing,” said Dr. Lisa Piercey, who heads the Tennessee Department of Health. “Physical space, physical beds, not the issue.”

When it comes to staffing, the coronavirus creates a compounding challenge.

As patient caseloads reach new highs, record numbers of hospital employees are themselves out sick with COVID-19 or temporarily forced to stop working because they have to quarantine after a possible exposure.

“But here’s the kicker,” said Dr. Alex Jahangir, who chairs Nashville’s coronavirus task force. “They’re not getting infected in the hospitals. In fact, hospitals for the most part are fairly safe. They’re getting infected in the community.”

Some states, like North Dakota, have already decided to allow COVID-positive nurses to keep working as long as they feel OK, a move that has generated backlash. The nursing shortage is so acute there that some traveling nurse positions posted pay of $8,000 a week. Some retired nurses and doctors were asked to consider returning to the workforce early in the pandemic, and at least 338 who were 65 or older have died of COVID-19.

In Tennessee, Gov. Bill Lee issued an emergency order loosening some regulatory restrictions on who can do what within a hospital, giving them more staffing flexibility.

For months, staffing in much of the country had been a concern behind the scenes. But it’s becoming palpable to any patient.

Dr. Jessica Rosen is an emergency physician at St. Thomas Health in Nashville, where having to divert patients to other hospitals has been rare over the past decade. She said it’s a common occurrence now.

“We have been frequently on diversion, meaning we don’t take transfers from other hospitals,” she said. “We try to send ambulances to other hospitals because we have no beds available.”

Even the region’s largest hospitals are filling up. This week, Vanderbilt University Medical Center made space in its children’s hospital for non-COVID patients. Its adult hospital has more than 700 beds. And like many other hospitals, it has had the challenge of staffing two intensive care units — one exclusively for COVID patients and another for everyone else.

And patients are coming from as far away as Arkansas and southwestern Virginia.

“The vast majority of our patients now in the intensive care unit are not coming in through our emergency department,” said Dr. Matthew Semler, a pulmonary specialist at VUMC who works with COVID patients.

“They’re being sent hours away to be at our hospital because all of the hospitals between here and where they present to the emergency department are on diversion.”

Semler said his hospital would typically bring in nurses from out of town to help. But there is nowhere to pull them from right now.

National provider groups are still moving personnel around, though increasingly it means leaving somewhere else short-staffed. Dr. James Johnson with the Nashville-based physician services company Envision has deployed reinforcements to Lubbock and El Paso, Texas, this month.

He said the country hasn’t hit it yet, but there’s a limit to hospital capacity.

“I honestly don’t know where that limit is,” he said.

At this point, the limitation won’t be ventilators or protective gear, he said. In most cases, it will be the medical workforce. People power.

Johnson, an Air Force veteran who treated wounded soldiers in Afghanistan, said he’s more focused than ever on trying to boost doctors’ morale and stave off burnout. He’s generally optimistic, especially after serving four weeks in New York City early in the pandemic.

“What we experienced in New York and happened in every episode since is that humanity rises to the occasion,” he said.

But Johnson said the sacrifices shouldn’t come just from the country’s health care workers. Everyone bears a responsibility, he said, to try to keep themselves and others from getting sick in the first place.

This story is from a reporting partnership that includes Nashville Public Radio, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Trabajadores agrícolas en alto riesgo de contraer coronavirus y sin protección federal

KNOXVILLE, Tennessee.- Es una época de mucho trabajo para las granjas productoras de tomate en esta parte del estado. Estas plantaciones cuentan con cientos de trabajadores, la mayoría latinos. Algunos viven allí. Otros son migrantes que viajan de granja en granja, para recoger las cosechas de verano. Otros vienen de México o Centroamérica con visas agrícolas temporales.

Pero este año, la temporada se desarrolla con enormes preocupaciones por el coronavirus que afecta directamente a estos trabajadores agrícolas.

“Casi todas las fases del proceso de recolección de tomates deben ser consideradas a la luz de COVID-19”, dijo Ken Silver, profesor asociado de salud ambiental en la Universidad Estatal del Este de Tennessee, que estudia la salud de los trabajadores migrantes en las plantaciones de tomates del estado.

Los trabajadores viven en alojamientos cerrados, durmiendo en literas y compartiendo baños y cocinas. Viajan a los campos en autobuses abarrotados y a menudo trabajan en grupos. Y aunque los empleados de las granjas son considerados trabajadores esenciales, suelen no tener seguro médico o licencia paga por enfermedad.

Las granjas ya han informado de brotes entre cientos de trabajadores en estados como California, Washington, Florida y Michigan. Sin embargo, el gobierno federal no ha establecido ninguna normativa para proteger a los trabajadores agrícolas del coronavirus o para instruir a los empleadores sobre lo que deben hacer cuando sus se enferman.

Mientras que organizaciones de defensa de los trabajadores migrantes dicen que esto permite a las granjas aprovecharse de sus trabajadores y aumentar su riesgo de exposición al coronavirus, las granjas aseguran que están haciendo lo que pueden para proteger a los trabajadores con los recursos limitados que tienen, mientras no se deja de hacer el trabajo.

Lo cierto es que la situación no está clara, expresó Alexis Guild, director de políticas y programas de salud de Farmworker Justice.

La responsabilidad de las granjas

En junio, 10 de los 80 trabajadores temporales de Jones & Church Farms en el condado de Unicoi, Tennessee, dieron positivo para el coronavirus. Otra granja en ese condado tenía 38 trabajadores que también dieron positivo alrededor de la misma época.

“Esto fue lo más aterrador que pudo pasarnos”, dijo Renea Jones Rogers, directora de seguridad alimentaria de la granja.

A nivel nacional, ha habido al menos 3,600 casos de trabajadores agrícolas que han dado positivo para COVID-19, según los informes de los medios de comunicación reunidos por el Centro Nacional para la Salud de los Trabajadores Agrícolas.

A esto hay que añadir que tanto los empleadores como los trabajadores agrícolas reconocen que incluso las intervenciones más básicas para frenar la transmisión —el distanciamiento social y el uso de máscaras— a menudo no son factibles, al trabajar en altas temperaturas.

Saúl, de 52 años, es un trabajador agrícola temporal que ha viajado de México a Virginia todos los años desde 1996 para cosechar tabaco. En una entrevista por WhatsApp, dijo que las máscaras son incómodas en el trabajo porque estás al aire libre: “Es incómodo porque trabajamos a la intemperie”. (Kaiser Health News no publica el apellido de Saúl para que no sea identificado por su empleador).

Saúl dijo que le preocupa el coronavirus, pero como vive en su lugar de trabajo, en la granja, se siente seguro.

Cuando llegó a los Estados Unidos en abril, la granja le proporcionó información sobre la pandemia, máscaras y desinfectante de manos, explicó. Nadie le toma la temperatura, pero trabaja en un grupo de ocho personas, vive con tres trabajadores más y nadie en la granja ha sido diagnosticado con COVID-19.

En Tennessee, Jones & Church Farms puso en marcha su propio protocolo de seguridad para los trabajadores al comienzo de la temporada. Esto incluyó el aumento de la desinfección, la toma de lecturas diarias de temperatura y el mantenimiento de los trabajadores en grupos para que vivan y trabajen con las mismas personas.

Después que los 10 trabajadores dieron positivo para COVID-19, la granja los mantuvo a todos en la misma vivienda y lejos de los demás. Los que eran asintomáticos también siguieron trabajando en los campos, aunque alejados de los otros, señaló Jones Rogers.

Si bien el Departamento de Trabajo no ha ofrecido normas federales de seguridad ejecutables para COVID-19, sí colaboró con los Centros para el Control y Prevención de Enfermedades (CDC) para elaborar un conjunto de pautas voluntarias y específicas para la agricultura. Esto se  publicó en junio, pocos días después que Jones & Church notificara del brote en la granja.

Mucho de lo que ya se había hecho en Jones & Church, sin embargo, seguía esas recomendaciones, que también sugerían que los trabajadores fueran examinados todos los días para detectar los síntomas de COVID-19 y que a los que se enfermaran se les diera su propio espacio para recuperarse alejados de los demás.

Otras sugerencias de los CDC y el Departamento de Trabajo, orientadas más hacia las factorías de procesamiento de alimentos, como las plantas de empaque de tomates, incluían la instalación de mamparas plásticas si no es posible que haya una distancia de 6 pies entre los trabajadores, la instalación de estaciones de lavado de manos y la provisión de equipos de protección personal o cubiertas de tela para la cara.

En junio, 10 de los 80 trabajadores temporales de Jones & Church Farms en el condado de Unicoi, en Tennessee, dieron positivo para COVID-19. Otra granja de la zona tuvo 38 trabajadores enfermos para la misma fecha. A nivel nacional, se han registrado al menos 3,400 casos positivos entre trabajadores agrícolas, según datos del National Center for Farmworker Health. (Victoria Knight/KHN)

Los activistas dicen que estas directrices son sólidas, en teoría. Su defecto más evidente es que son voluntarias.

“No creemos que la salud y la seguridad de los trabajadores deban dejarse a la buena voluntad de los empleadores”, señaló María Perales Sánchez, coordinadora de comunicaciones del Centro de Los Derechos del Migrante, una organización con oficinas en México y en los Estados Unidos.

Un vocero del Departamento de Trabajo ofreció una perspectiva diferente. “Los empleadores son y seguirán siendo responsables de proporcionar un lugar de trabajo libre de riesgos conocidos para la salud y la seguridad”, indicó, y añadió que los estándares de seguridad general preexistentes de la Administración de Seguridad y Salud Ocupacional (OSHA) y las directrices de los CDC se utilizan para determinar las violaciones a la seguridad en el lugar de trabajo. La OSHA es una agencia del Departamento de Trabajo.

La industria agrícola ha expresado su temor ante cualquier aumento de la regulación federal.

“No creo que OSHA pueda implementar un tipo de regulación obligatoria que no ponga en desventaja a algunos agricultores”, apuntó Allison Crittenden, directora de relaciones con el Congreso de la American Farm Bureau Federation.

Las granjas ya han tomado muchas medidas contra COVID-19, añadió, “y si estas acciones se están llevando a cabo de forma voluntaria, no vemos la razón de imponer un requisito obligatorio”.

Dificultades para acceder a la atención médica

Los trabajadores agrícolas migrantes, a pesar de ocupar un eslabón esencial en la cadena de suministro de alimentos del país, a menudo no reciben prestaciones en el lugar de trabajo, como seguro médico o licencia de enfermedad remunerada.

Saúl, el trabajador agrícola del tabaco de Virginia, dijo que no creía tener ningún seguro médico. Si se enfermara, tendría que decírselo a su empleador, que luego tendría que llevarlo al médico. La ciudad más cercana a la granja está a 15 millas. ¿Quién es responsable de estos costos? ¿El trabajador o la granja? Depende de las circunstancias individuales.

Muchas granjas emplean principalmente trabajadores latinos, y los datos de los CDC ilustran que es mucho más probable que los latinos se infecten, deban hospitalizarse o mueran por complicaciones de COVID que los blancos no hispanos. Los expertos también advierten que debido a que la pandemia de COVID está afectando desproporcionadamente a las personas de minorías, podría ampliar las disparidades de salud preexistentes.

Además, buscar la atención de un médico puede resultar riesgoso para los trabajadores agrícolas migrantes. Los trabajadores indocumentados pueden temer ser detenidos por autoridades de Immigración mientras que los que tienen la residencia permanente (green card) les puede preocupar la “regla de la carga pública” que la administración Trump endureció.

Esta polémica “regla” tiene en cuenta el uso de los programas públicos, incluyendo la atención sanitaria, a la hora de una solicitud de ciudadanía. Sin embargo, el gobierno federal ha dicho que buscar tratamiento por COVID-19 no aplicaría para esa regla.

Y aunque el rastreo de contactos es importante para detener la propagación de COVID-19 entre los trabajadores agrícolas, muchos departamentos de salud no cuentan con traductores que puedan hablar español o lenguas indígenas centroamericanas, ni ha habido un rastreo sistemático a nivel nacional de los brotes de los trabajadores agrícolas hasta ahora, como se ha hecho con los brotes en las instalaciones de cuidados a largo plazo.

Por lo tanto, “es muy difícil saber cuántos trabajadores agrícolas específicamente están dando positivo,” expresó Guild, de Farmworker Justice.

Eso podría ser un problema para rastrear los brotes, especialmente cuando la temporada de cosecha aumenta para ciertos cultivos y las granjas incrementan su fuerza laboral.

A fines de julio, llegaron a Jones & Church Farms casi 90 trabajadores temporales adicionales para ayudar a cosechar tomates hasta octubre, apuntó Jones Rogers. Aunque los 10 trabajadores que tenían COVID-19 se han recuperado, dijo que teme que si más personas contraen la enfermedad, no habrá suficientes viviendas para mantener a los trabajadores enfermos aislados o suficientes trabajadores sanos para la cosecha.

“Los tomates no esperan a que todos se sientan bien para que se los recoja”, añadió Jones Rogers.

La reportera Carmen Heredia Rodríguez y Katie Saviano asistieron con traducción al español para esta historia.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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As Crisis Grows, Farms Try to Balance Health of Field Workers and Food Supply

KNOXVILLE, Tenn. — It’s a busy time for the tomato-producing farms in this part of the state. Farms have staffed up with hundreds of workers, most of whom are Latino. Some live locally. Others are migrant workers who travel from farm to farm, chasing the summer growing seasons. Still others come from Mexico or Central America on temporary agricultural visas to work at certain farms.

But, this year, the season is taking place under a cloud of coronavirus worries that, for these agricultural workers, hit close to home.

“Almost every part of the process for picking tomatoes needs to be considered in light of COVID-19,” said Ken Silver, an associate professor of environmental health at East Tennessee State University, who studies migrant worker health on Tennessee tomato farms.

After all, the workers live in close quarters, sleeping in bunk beds, and sharing bathrooms and kitchens. They ride crowded buses to fields and often work in groups. And even though farm employees are deemed essential workers, they often don’t have health insurance or paid sick leave.

Farms have already reported outbreaks among hundreds of workers in states that include California, Washington, Florida and Michigan. And yet, the federal government has not established any enforceable rules either to protect farmworkers from the coronavirus or to instruct employers what to do when their workers get sick. While migrant worker advocacy groups say this allows farms to take advantage of their workers and increase their risk of exposure to the coronavirus, farms say they’re doing what they can to protect workers with the limited resources they have, while also getting their crops harvested.

The situation certainly isn’t clear-cut, said Alexis Guild, director of health policy and programs at the advocacy group, Farmworker Justice.

Leaving It Up to the Farms

In June, 10 temporary workers out of about 80 at the Jones & Church Farms in Unicoi County, Tennessee, tested positive for the coronavirus. Another farm in that county had 38 workers test positive around the same time.

“This was the scariest thing that could happen,” said Renea Jones Rogers, the farm’s food safety director.

Nationally, there have been at least 3,600 cases of farmworkers testing positive for COVID-19, according to media reports gathered by the National Center for Farmworker Health.

Add to this that farm employers and workers alike acknowledge that even the most basic interventions to stop transmission — social distancing and mask-wearing — often aren’t feasible, especially in the hot temperatures.

Saul, 52, is a temporary farmworker who has traveled from Mexico to Virginia every year since 1996 to harvest tobacco. In a WhatsApp message interview, he said masks are uncomfortable on the job because he is working outdoors, writing in Spanish, “En el trabajo es incómodo porque trabajamos al intemperie.” (Kaiser Health News is not publishing Saul’s last name so that he won’t be identified by his employer.)

Saul said he does worry about the coronavirus, but because he lives at his job on the farm, he feels safe.

When he arrived in the U.S. in April, the farm provided him with information about the pandemic, masks and hand sanitizer, he said. Nobody takes his temperature, but he works in a crew of eight, lives with only three other workers and nobody on the farm has yet been diagnosed with COVID-19.

In Tennessee, the Jones & Church Farms put its own worker safety protocols in place at the beginning of the season. These included increasing sanitation, taking daily temperature readings and keeping workers in groups so they live and work with the same people.

After the 10 workers tested positive for COVID-19, the farm kept them all in the same housing unit and away from the other workers — but those who were asymptomatic also kept working in the fields, though they were able to stay away from others on the job, said Jones Rogers.

While the Department of Labor has not offered enforceable federal safety standards for COVID-19, it did collaborate with the Centers for Disease Control and Prevention to publish a set of voluntary, agriculture-specific guidelines. Those were released in June, just days after Jones & Church became aware of the farm’s outbreak.

Much of what had already been done at Jones & Church, though, tracked closely with those recommendations, which also suggested that workers be screened every day for COVID-19 symptoms and that those who become sick be given their own space to recover apart from others.

Other suggestions in the CDC and Labor Department directive, geared more toward indoor food-processing factories such as tomato-packing plants, included installing plastic shields if 6 feet of distance isn’t possible between workers, putting in hand-washing stations and providing personal protective equipment or cloth face coverings.

In June, 10 of about 80 temporary workers at Jones & Church Farms in Unicoi County, Tennessee, tested positive for COVID-19. Another farm in the county had 38 workers test positive around the same time. Nationally, at least 3,400 positive cases among farmworkers have been counted, according to media reports gathered by the National Center for Farmworker Health. (Victoria Knight/KHN)

Advocates say these guidelines are sound, in theory. Their glaring flaw is that they are voluntary.

“We don’t believe that the health and safety of workers should be left to the goodwill of employers,” said María Perales Sanchez, communications coordinator for Centro de Los Derechos del Migrante, an advocacy group with offices in both Mexico and the U.S.

A Department of Labor spokesperson offered a different take. “Employers are and will continue to be responsible for providing a workplace free of known health and safety hazards,” the spokesperson said, adding that the Occupational Safety and Health Administration’s preexisting general-safety standards and CDC guidelines are used to determine workplace safety violations. OSHA is an agency within the Labor Department.

Farm industry groups are apprehensive of any increased federal regulation.

“I don’t think OSHA would be able to have some sort of mandatory regulation that wouldn’t disadvantage some farmers,” said Allison Crittenden, director of congressional relations for the American Farm Bureau Federation.

Farms have already put many COVID-19 protections in place, she said, “and if these actions are taking place in a voluntary way, we don’t see that we need to have a mandatory requirement.”

Difficulties in Accessing Health Care

Migrant farmworkers, despite occupying an essential link in the country’s food supply chain, often aren’t provided with workplace benefits like health insurance or paid sick leave.

Saul, the Virginia tobacco farmworker, said he didn’t believe he has any health insurance. If he gets sick, he would need to tell his farm employer, who would then have to drive him to the doctor. The closest city to the farm is 15 miles away. Who is responsible for these costs — the worker or the farm — depends on individual circumstances.

Many farms employ mostly Latino workers, and CDC data illustrates that it’s much more likely for Hispanic or Latino people to be infected, hospitalized or die from COVID complications than white people. Experts also warn that because the COVID pandemic is disproportionately affecting people of color, it could widen preexisting health disparities.

Also, seeking a doctor’s care can feel risky for migrant farmworkers. Workers who are undocumented may worry about being detained by Immigration and Customs Enforcement, while workers who have green cards may be concerned about the Trump administration’s “public charge rule.” This controversial rule weighs immigrants’ use of public programs, including health care, against their applications for citizenship. However, the federal government has said seeking treatment for COVID-19 wouldn’t fall under the rule.

And while contact tracing is important to stop the spread of COVID-19 among farmworkers, many health departments don’t have translators on staff who can speak Spanish or Indigenous Central American languages, nor has there been a systematic nationwide tracking of farmworker outbreaks thus far, as has been done with long-term care facilities outbreaks.

So “it’s really hard to get a grasp on how many farmworkers specifically are testing positive,” said Guild, with Farmworker Justice.

That could be an issue for tracing outbreaks, especially as the harvesting season ramps up for certain crops and farms bolster their workforces.

At the end of July, almost 90 additional temporary workers arrived at Jones & Church Farms to help harvest tomatoes through October, said Jones Rogers. Though the 10 workers who had COVID-19 have recovered, she said she’s scared that if more get the disease, there won’t be enough housing to keep sick workers separate from others or enough healthy workers to harvest the crops.

“Tomatoes don’t wait until everyone is feeling good to be harvested,” said Jones Rogers.

Reporter Carmen Heredia Rodriguez and Katie Saviano provided Spanish translation assistance for this story.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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